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P.O. Box 14088, Lexington, Kentucky 40512

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Complaints & Reviews

Denied me upper and lower jaw surgery

Aetna Health Insurance has approved me part of my surgery but denied me the upper and lower jaw surgery of my surgery. I have an underdeveloped upper and lower jaw (hypoplasia), non union of jawbone, decreased airway at 4mm (normal is 11mm), decreased ROM at 5mm (normal is 40mm), misaligned jaws, pain, headaches. It was determined by a world renowned surgeon that I needed joint surgery combined with jaw surgeries to completely correct my problems. They denied me on the grounds they feel the jaw surgeries are cosmetic despite the fact that six different doctors have written letters to Aetna stating the medical necessity of my surgery. My surgeon even stated my airway is not increased could be life threatening and my non-union of bone could cause infection or eventually loss of bone. Despite this Aetna continues to deny the jaw surgeries. My surgeon even wrote a letter to Aetna stating I have a 4mm transverse deficiency which falls under their guidelines to cover Orthographic surgery.

  • Ti
    ticked123 Feb 20, 2009

    I am so tired of hearing people moan and groan about insurance companies denying them services. What people fail to realize is that the bottom line with services that are not covered or denied for whatever reasons is that 9 times out of ten if a procedure or service is not covered it is the fault of the employer that group insurance policies are obtained through. A perfect case in point is Bariatric surgery I cant even tell you how many times I have talked to someone that is totally outraged over the fact that Aetna or another insurance carrier is denying a medically necessary procedure. I have never heard such a whiney society! First of all, the customer service rep that you call and yell and scream at because you need this surgery because you are morbidly obese cant do a thing to change the fact that this is not covered; Have a conversation with your employer if you are ticked that you cant have this surgery. I am the first to admit that Bariatric surgery is a necessity for some people but for all of you people out there that want to eat whatever you please and gain tons of weight and then have an invasive surgical procedure to fix it don’t expect your insurance to cover this. The deductible and co insurance rates as well as co-pays are no exception to this rule, the employer works with the health insurance carrier to put together a plan that the employer can AFFORD. In reality if they pick the lower co-pay or deductible they are going to pass that expense along to you in your premiums, then everyone will complain about their premiums, which again the health carrier has NOTHING TO DO WITH. We as a society expect that everything be free in life, especially health benefits. NEWSFLASH nothing in life is free and anything pertaining to the health care field is going to be expensive. Don’t expect to get insurance or health care for free because its not going to happen. It is very frustrating to take calls from members who are screaming and yelling at you about things that you cant change and have nothing to do with. So the next time that you get on the phone and are screaming profanities at the customer service rep think twice about where your anger should be directed. Your plan is mostly based on what your employer is willing to pay for and what they want YOUR premiums to be. Think about this, you don’t buy a car without first doing research on the vehicle luxuries and gas mileage you want to get the most for your money. When its time to renew your benefits do some research LIKE YOU WOULD ON ANYTHING ELSE YOU ARE SPENDING MONEY ON!

    -3 Votes
  • Ol
    oldster Mar 09, 2009

    Dear ticked - -Wow - where did you get that anger? Maybe you should ask your insurance company to pay for some counseling? I am sick of insurance companies asking their CUSTOMERS to make lifestyle changes, healthy choices - -like not smoking for example - --and then denying coverage for things like obesity surgery. You can quit cigarettes - - you cannot quit food. Sorry - -it's not as simplistic as you make it out to be. Obesity is caused by many factors - -and it's a shame that insurance companies are willing to replace kidneys, hearts and lungs of people who have abused themselves all their lives - -with cigarettes. YET - -they won't cover a surgery that will help someone change their life. My husband is trying to get the obesity surgery to help himself live a better life - -to help himself get off some of the medications he is on - -diabetic and blood pressure - -to help him live longer, to help him exercise better WITHOUT so much expense for health care - --
    You can't say that about cigarette smokers or alcoholics who have ruined their organs and need transplants and other costly interventions. Most of them (at least from my experience)if they don't need or are qualified for transplants suffer eventually from emphysema, COPD, heart disease/congestive heart failure, cirrhosis, etc. I do expect our insurance company to cover his surgery - -just as they would cover any other necessary surgery.

    1 Votes
  • Th
    thesporksofdoom Feb 03, 2011

    I have the same problem with my insurance just not as severe. I have an underdeveloped lower jaw and worsening tmj problems. I meet every factor to make this surgery medically necessary according to my insurance yet despite my efforts they still choose to claim that is is a purely cosmetic surgery. The fact is that it is clearly worsening as I get older and developing new ways to affect my quality of life and ability to live properly. My doctor had warned me that all insurance companies have their heads up their [censor] around this particular issue, and I must say it seems to be very true. I got here by scouring the internet for clues and help trying to convince my insurance company. I wish you the best of luck!

    I get what your saying ticked about people expecting everything to be taken care of for them. I however do not see how you relate the need of this surgery to obesity. There is now choice that you make that ends up putting you in the position of needing this surgery. It is something that you develop from your time of conception, there is no life choice here. Also why would you buy insurance if its only going to cover the little things that you could probably handle on your own? I believe most people buy insurance to cover their [censor] when something happens that they cannot afford. Like for example a ~$15, 000 surgery on the low end to fix your jaw. You might not see jaw issues as a severe life affecting problem but thats because its quite clear that you have not experienced them. Come back to say how whiny needed this surgery makes you when you can't eat because your jaw hurts after a few bites (think about that your jaw hurts so bad that even after being ravenous a couple bites in you loose your appetite), after talking for a couple minutes, not being able to eat many foods, having your jaw lock and become immobilized so you cant talk..ect. If you want to reexamine your argument and actually make it relevant to this issue please feel free.

    Good point oldster! You get insurance to cover your [censor] despite your life choices thats why high risk people have to pay more!

    0 Votes

Outraged

Aetna has prohibited Houston members from receiving Airrosti therapy (rapid recovery therapy) on a self-pay basis for the past two months.

Airrosti was an Aetna participating provider. Airrosti physicians perform their services within primary care physician’s offices here in Houston. The problem began when Aetna and Airrosti entered in contract

negotiations two months ago. Aetna threatened their PCP'S with contract violation and possible contract termination if their Houston members

received Airrosti therapy on site. As such, Houston Aetna patients couldn't receive Airrosti therapy on a cash or out-of-network basis.

Aetna's legal department recently ruled that members could receive Airrosti services on a self-pay or out-of network basis. Such services

would be process under Airrosti separate tax ID. Aetna's recent communication

to their PCP's reiterated the risk of contract violation and termination if PCP's violate their fiduciary responsibilities to Aetna by referring

to out-of-network providers.

It is illegal for a health care provider to limit access to medical services for their members on a self-pay basis. Aetna commands approximately 30% of the Houston patient population.

  • Je
    Jeff Sep 09, 2008
    This comment was posted by
    a verified customer
    Verified customer

    Situations involving ones health become such a testy and important event. No one feels like taking chances or playing games when they are not well. And who can blame them. http://www.phoenix-life-insurance.com. I hope health insurance providers come to their senses or they will only give more ammunition to the people who want to nationalize health care. It's a delicate situation.

    0 Votes
  • Jd
    J don gordon Sep 19, 2008
    This comment was posted by
    a verified customer
    Verified customer

    Aetna has provided my wife and me great service over the past nine years.

    Surely there are always complaints about Health Insurance Providers and Physicians and other Health Service Providers. However, these complaints are small in number in comparison to the total amount of service provided.

    I have had my issues with Physicians; however, we are not perfect; and we can not expect them to be perfect. Nor can we expect our Insurance Providers to be perfect.

    They do not resolve all of our complaints and health issues instantaneously or perfectly and should not be expected to do so. They do the best they can as each of us does.

    I suggest we each give thanks daily for our Physicians and other Health Service Providers and our Health Insurance Providers.

    They have many dedicated people who are compassionate and caring and who have to deal with the same people in the Healthcare System each of us has to deal with.

    Let us work for improvement, not perfection, a step at a time, a day at a time. Let us work together. We seem to get further that way.

    By the way in case you are wondering, I am and have been a senior accountant in industry for some thirty years.

    Let us all breathe deeply several times, in and out of course, release slowly and welcome the state of peace, grace and thankfulness, which comes with this process.

    J. Don

    0 Votes
  • Ti
    ticked123 Feb 20, 2009

    I am so tired of hearing people moan and groan about insurance companies denying them services. What people fail to realize is that the bottom line with services that are not covered or denied for whatever reasons is that 9 times out of ten if a procedure or service is not covered it is the fault of the employer that group insurance policies are obtained through. A perfect case in point is Bariatric surgery I cant even tell you how many times I have talked to someone that is totally outraged over the fact that Aetna or another insurance carrier is denying a medically necessary procedure. I have never heard such a whiney society! First of all, the customer service rep that you call and yell and scream at because you need this surgery because you are morbidly obese cant do a thing to change the fact that this is not covered; Have a conversation with your employer if you are ticked that you cant have this surgery. I am the first to admit that Bariatric surgery is a necessity for some people but for all of you people out there that want to eat whatever you please and gain tons of weight and then have an invasive surgical procedure to fix it don’t expect your insurance to cover this. The deductible and co insurance rates as well as co-pays are no exception to this rule, the employer works with the health insurance carrier to put together a plan that the employer can AFFORD. In reality if they pick the lower co-pay or deductible they are going to pass that expense along to you in your premiums, then everyone will complain about their premiums, which again the health carrier has NOTHING TO DO WITH. We as a society expect that everything be free in life, especially health benefits. NEWSFLASH nothing in life is free and anything pertaining to the health care field is going to be expensive. Don’t expect to get insurance or health care for free because its not going to happen. It is very frustrating to take calls from members who are screaming and yelling at you about things that you cant change and have nothing to do with. So the next time that you get on the phone and are screaming profanities at the customer service rep think twice about where your anger should be directed. Your plan is mostly based on what your employer is willing to pay for and what they want YOUR premiums to be. Think about this, you don’t buy a car without first doing research on the vehicle luxuries and gas mileage you want to get the most for your money. When its time to renew your benefits do some research LIKE YOU WOULD ON ANYTHING ELSE YOU ARE SPENDING MONEY ON!

    0 Votes

Denial of STD Claim

I e-mailed a detailed complaint about my STD Claim from Aetna who is BMWMC's provider through Blue Cross Blue Shield. I know you have thousands of complaint's but this injustice is happening with a company who provides thousands of jobs for this state. I am in danger of losing my job after having a complete hyterectomy with additional surgery on my bladder. They have denied the claim. I'm on my third appeal. Please contact or suggest another source I can contact for this injustice!!!

Helen

Denial of STD. Placing 3rd appeal

I gave you my cell number. I have been an employee at BMW for almost 9 years. Feb.14, 2008 I entered...

Non Payment of Medical Bills

I was disabled in 1999 from the results of a car accident. I am paying for Aetna insurance through my company disability plans and I also receive Medicare A, because it is free. I have no other insurance and never have since I have been disable or have been with Aetna Insurance. Nothing has ever changed since I have been with Aetna, just my age or PCP. I have been receiving Medicare A since 4/01/2000.

I don't know what Aetna is trying to pull this year, and I understand I am not the only one this is happening too. They have stop making payments on all my medical bills and telling my doctors that I am not providing them with information needed for processing the bills. Aetna is saying that I have other insurance.

I have filled out two forms from auditors, may calls, sent messages, and have updated their database and still no one can get it right.

I have bills coming in that I can not afford to pay, and someone making calls to my home(I was not there) I was going to be dropped, plus I appear to be not responsible to the doctors office, because Aetna keeps telling the doctors that I don't return their calls.

I am going to take legal action against Aetna if I can through the state of Virginia.

  • Jo
    joe Nov 10, 2008
    This comment was posted by
    a verified customer
    Verified customer

    I am new patient with Aetna right off they refuse to pay my lab work no referral, etc.
    bull. i was sent by my primary care physician with a slip to lab corp this should be paid, no questions
    they want it to be a med emergency i say they are trying to intimidate me into not seeking out services
    joe sang vineland nj

    0 Votes

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Scam and cheating!

My wife has been disabled since 1988. She receives a monthly disability check and is enrolled in Part A only. We opted not to enroll in Part B since she is covered by my health plan at work. We reasoned why pay out the additional monthly cost. My wife and I are both in our 50's. I have had no problems all these years until a few months ago. I noticed Aetna was holding all claims with the reason being additional information was required. After many many calls and emails to Aetna Customer Service (or lack thereof) I found out that they showed my wife was in both Part A & Part B. The representative was told that in no uncertain terms that my wife has never been enrolled in Part B. She then confirmed this with the local SS office. She told me the claims would be resent to processing.

Now the bad news.

All of my claims going back to May 7, 2007 were then re done as if my wife had been enrolled in Part B. So far (it keeps changing ever time I visit their web site) I have gone from about $700 out of my pocket to over $20,000. The new EOB (Explanation of Benefits) now states and I quote 'Your plan reduces covered expenses by Medicare benefits for which you are eligible, whether or not you are actually enrolled in Medicare.' My question is what are my options, is this legal?

I am concerned too, that next they may say my wife was eligible for Part D and they will quit paying for her prescriptions. Which run over $1500 per month.

Any insight is greatly appreciated.

  • In
    insurance expert Nov 28, 2008
    This comment was posted by
    a verified customer
    Verified customer

    are you on a retiree plan or an active employee plan? certain plans are designed to work as secondary to medicare, meaning, they are there to supplement medicare. If you chose not to take medicare, the plan malfunctions, meaning, the plan will only pay what it WOULD have paid, if you had medicare. So they assume the Part B payment. Its a very legitimate practice. Unfortunately, you were never made aware of this so now you are stuck with these very large bills.

    0 Votes
  • Mi
    Mike Michalak Aug 15, 2018
    This comment was posted by
    a verified customer
    Verified customer

    Aetna Insurance
    Charles M. Michalak
    Claim Number 17288018
    2/9/2018

    Aetna has done nothing but make my Short Term Disability Claim a nightmare. They have stalled, made false claims of not getting paperwork and failed to talk to my Doctor. They denied my appeal. They are dishonest and causing me further stress.

    0 Votes

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